Provider Demographics
NPI:1063006013
Name:ADJOODANI, PARRI B
Entity Type:Individual
Prefix:MRS
First Name:PARRI
Middle Name:B
Last Name:ADJOODANI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PARRI
Other - Middle Name:B
Other - Last Name:ADJOODANI-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSFA
Mailing Address - Street 1:3037 WENDLOCK DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1406
Mailing Address - Country:US
Mailing Address - Phone:404-273-5164
Mailing Address - Fax:
Practice Address - Street 1:15200 COMMUNITY RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3085
Practice Address - Country:US
Practice Address - Phone:404-273-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
163297OtherTHE NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING